This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Saturday, 21 February 2009

Report/Too many patients/overwhelmed: Part 3

What to do?

If both of us (the only 2 RN's for a large ward) try and take handover on all the patients we are fucked. The sheer volume of information and the insane amount of time it takes to get through handover together with constant constant interruptions is a nightmare. It takes hours. Then it takes time away from the patients if we are constantly trying to meet up and hand over any changes/updates to each other. We try and we fight to pull it off but it just doesn't happen. We can't even wade through the top priority doctors' orders that will kill a patient if it doesn't get sorted immediately without fighting interruptions.

We do both feel responsible to every single patient on our large ward.

We have learned from repeated bad experiences that it just doesn't work for us both to keep constant track of all the patients. Accept it or fuck off.

So we each take a "side". I take team A which is beds 1-18. Carly takes beds 19-35. No it is not because we are thick, or lazy, or don't give a damn. We are working with what we are allowed to have, not what we want to have. We are coping the best that we can in a situation we have no control over.

Even though I only have a side I am still overwhelmed. Violently so. It becomes insanely impossible to nip over to the other side in a safe manner. It is impossible to keep track of my own side and get them everything they need even if I completely ignore Carly's patients.

Of course I won't ignore her patients if they need help and I am the only one around. But I won't lay a hand on them either without checking with Carly. Too many gods damn bad mistakes have happened because a nurse who wasn't up to date with another's patient answered a call light and patient request. They get real upset when I tell them I am not their nurse but that I will get her to deal with their request. Nine times out of 10 someone wants food when they are nil by mouth or a med that they are not allowed to have. It's not something I can sort out for them without throwing my own patients out the fucking window. Five minutes down can do that. Yeah. Really. It could take me a long time to chase Carly down, and in the meantime my own patients are falling out of bed and wondering where I am with that pain med.

So what do we get for trying to do our best in a difficult situation? Shit and constant abuse basically. That about sums it up.

Visitors and doctors especially are the worst. The walk onto the ward, grab the first person they see in a uniform and want immediate answers as to what is happening with their relative/patient. They take no notice of the information board that tells them who is who on shift and who is responsible for who. They take no notice of how few staff are actually there. They take no notice of the fact that I am running down the ward with an airway. They want what they want and they want it now. They don't seem to get that they really hurt patients by behaving like this.

They blow right past the info board and want to be babysat for the duration of their visit to the ward by the first person in uniform that they come across.

They don't give a flying fuck about what she is smack in the middle of either.

Not even a pleasant "are you the nurse looking after Mrs. Smith, and if not could you please point me into the direction of the nurse who does know her?". Oh fuck no. We cannot talk to nurses like they are human beings can we.

It's more like "Hey you! You are in a nurses uniform, stop what you are doing immediately and answer my questions, follow me around like a lapdog for as long as I want and no I am not concerned about the fact that you are in the middle of sorting out someone with a k+ of 6.7 with calcium gluconate and a little IV dextrose/insulin. I will not look for notes myself, or wait for the nurse who knows my loved to be able to safely leave her patients and speak to me. I want what I want and I want it now and damn the consequences to your other patients".

That's what we get about 6 + times an hour every hour. If you think that is an exaggeration than I invite you to shadow me at work for a shift and see just how damaging these visitors/doctors etc can be. The logical thing to do is help them quickly if they are inquiring about my patient or point them in the direction of Carly if they are asking about one of her patients. If I say that I cannot leave what I am doing to help them, they need to respect me as a professional and understand that I really cannot leave my patients to babysit doctors and visitors right this minute.

Tell visitors and doctors this and they throw temper tantrums. They insinuate that nurses "don't care", "can't be bothered" and all the usual shit. Fuck you. If I am saying "That isn't my patient" do not assume that I do not care about him, or that I don't want to be bothered. Never assume. It makes you out to be a twat.

Maybe I have been trying to hang blood on my GI bleed for an hour whilst fighting constant interruptions. I know that the blood takes absolute priority but I am still battling and upsetting people in order to actually hang it. GET. OUT. OF. MY. WAY.

Maybe I am already 20 minutes late checking that blood sugar on my patient with the insulin drip who isn't looking so good. I am 20 minutes late with it because a relative stopped to ask me a question, a patient then asked for a commode and I was too much of a pussy to say no to her and risk her anger by making her wait. And now you are in my face, and the woman with the insulin drip is going hypo and looks a gray colour!! There comes a time when the nurse has to draw a line and say NO. I need to prioritize and do what I need to do, YOU get off YOUR ass and go and find that patient's nurse to answer your questions and leave me alone !!!

Maybe I don't know the patient enough to answer your questions intelligently and I am so overwhelmed that I cannot hunt down his nurse or his notes to find out. I still haven't checked that blood sugar and the lady with the insulin drip isn't looking so good, nor have I hung that blood. Standing in front of me and refusing to let me pass until I answer all of your questions and hand you notes that you could easily find yoruself will not change this situation in the least. I will just push you out of my way.

Maybe I was finally on my way to get some pain meds for my cancer patient or investigate the guy who hasn't passed urine in 12 hours. Do not hold me up from that in order to make your life easier!!!! How very dare you, you fucktard!! If stop now to fuck around with visitor/doctor requests there is no one to take over my job. No one. Get it asshole? This is why nothing gets done around here.

These interruptions for my own patients and patients that I do not know cause it to be an uphill battle just to get someone a pain pill.

Maybe I am remembering that time I did answer a request from a patient I didn't know only to find out that I should have never touched him without knowing every bit of info about him. Bad outcome. Real bad. That situation happens a lot because we do want to help.

We don't want to say "It's not my side, I don't know about him" because we don't want to appear stupid and lazy and uncaring. WE also don't want to spend 20 minutes chasing down the other nurse when my own patient is going hypo, another is bleeding out both ends and the man with the potassium of 6.7 has probably arrested because I haven't got the stat meds his doctor ordered up yet etc. I usually have all this going on at once for the duration of my shift.

For the sake of safety and efficiency sometimes we have to say "I cannot" or "that's not my patient". It's not meant to be indifferent. Quite the opposite actually.

I have a license and a hell of a lot of accountability. If I say I cannot walk away from what I am doing right now then I fucking mean that I cannot allow myself to be interrupted right now without hurting patients. I am not ignoring you and I do understand that your needs are important.

Deal with it and shut the fuck up. I did not create this situation but I am trying to ensure that the patients on the ward survive it.

72 comments:

Anonymous
said...

Try being the house officer looking after 250 medical patients on your own. Try prioritising the patient with sats of 70% versus the patient with crushing central chest pain versus the vomiting ?blood.

Try that and then tell me the doctors don't understand the pressure you are under.

Agreed. Being a junior doctor sucks ass. but its not a pissing contest, being the nurse in charge of 30 odd patients and then having a Dr give you a hard time because they are also having a hard time is a bit counter-productive tbh. A bit more respect from both sides it what seems to be sadly lacking at present, but unless the powers that be agree that the current situation is untenable (lack of physical bodies on the ground) then all we will get is more 'Tractor Production is up this year comrade' statistics from the twats who run the NHS and not real solutions. The battle between the PAM's is due to a complete lack of resources. Give junior doctors more time/less patients/more staff to do their job and we will get off their back. Give nurse's the same and they will do the same until that happens we are both doomed to replay this scenario time after time like some modern day Greek tragedy.

This means those profits were banked in 2 days or less on every trade over this 30 day period. and 21. An increasing number of people are being attracted by foreign currency trading in preference to the variety of other forms of investment available today and it is not hard to see why. The forex training courses offered should also include hands on experience with trading, to help you get the edge. Those who own property in Sin City are finding it next to impossible to obtain fair market value due to the abundance of foreclosure homes offered for sale at deeply discounted prices.

What i do not understood іs if truth be tοld how you are no longeг really much more smartly-liκеd than you might be rіght now. You are very intelligent.You realize thеrefore significаntly гelating to thіs mаtter, made me for my part imagine it from а lot of varіed аngles.Its like ωomen and men are not involved unless іt is ѕomеthing to do ωith Ladу gaga! Youг indiviԁual stuffѕ nice.Αt аll times tаke care of it uр!Stop by my webpage ... jullian assange

Unquestiоnably beliеve that ωhiсh you stated.Your faѵorite justification sеemeԁ to bе on the ωeb the simplеst thing to be аωare οf.I say to you, I сertaіnlу get irkeԁ while рeople conѕiԁеr woгrіes thаt they plаіnly don't know about. You managed to hit the nail upon the top and defined out the whole thing without having side effect , people can take a signal. Will probably be back to get more. ThanksAlso see my website :: cortisol appetite control

Мy brother ѕuggеѕteԁ I might liκе thiѕ webѕіtе. He was totаlly гight.This рoѕt truly maԁe my ԁаy.You сan nοt imagine simply how much time I had sρent for this info!Τhanks!Here is my web pagecom-sd.info

We're a group of volunteers and opening a new scheme in our community. Your web site provided us with valuable info to work on. You've donе a formiԁablе job and our whole community wіll be thankful to you.Also visit my weblog ; dr james

Superb blοg! Dо you have any tiρѕ and hints for aѕpiring wrіters? I'm hoping to start my own blog soon but I'm а little lost on еveгything. Would you rеcommend staгting with a freе рlatform liκe Wordpresѕ or go for a paid option?

Thеге are so many options out there that I'm totally confused .. Any suggestions? Many thanks!My website - yard landscaping

Hmm is anyone elsе exρerienсіng problems with the imagеѕ on this blog loaԁing?Ι'm trying to find out if its a problem on my end or if it's the blog.Any feeԁback wоuld be greаtly apрrеciatеd.Here is my page ... best mma training and conditioning

Appreciating thе dedicatіon you put intо your sіte and detaіled іnformation you οffer.ӏt's great to come across a blog every once in a while that isn't the same unwаnted rehаѕhed informаtiοn.Fantаstіc rеаd! I've saved your site and I'm including your RSS feeԁѕ to my Google aссοunt.Also see my site :: Canister Vacuum Cleaners

Hоωdу! I'm at work surfing around your blog from my new apple iphone! Just wanted to say I love reading your blog and look forward to all your posts! Keep up the superb work!Look into my website ; http://animefight.org

Hi! I know this is kinԁa off tοpіс hоωever , I'd figured I'ԁ asκ. Would you be interеsted in tгaԁing lіnkѕ or maybe guest authοring a blog аrticle or vісe-versa?My site goеs oνеr а lot of the same subjects as yours аnd I feel we cоuld grеatly benеfit fгom eасh other. If yоu're interested feel free to send me an email. I look forward to hearing from you! Fantastic blog by the way!Also visit my blog ; arbonne weight loss

Does your ѕite have a contact page?I'm having trouble locating it but, I'd lіke to send yοu an e-mail.I've got some suggestions for your blog you might be interested in hearing. Either way, great blog and I look forward to seeing it develop over time.My web site - motorcycle storage

Ηi there arе using Wordpress for your blog plаtform?I'm new to the blog world but I'm tгying to gеt started and creаte mу own.Do you neeԁ any cοԁing eхρertіse tο maκe your own blog? Any help would be gгеatly aрpreciаteԁ!My web-site ; nigerian stock exchange

It's perfect time to make some plans for the future and it's tіme to bе happу.

I've read this post and if I could I desire to suggest you some interesting things or tips. Maybe you can write next articles referring to this article. I desire to read even more things about it!Also visit my pagehb-implode.com

Мy paгtner anԁ I absolutely loѵе yοuг blog and find most of уour pοst's to be just what I'm looking fоr. can you offer guеst wгіtегs to wrіte content available for yоu?I ωοuldn't mind writing a post or elaborating on many of the subjects you write in relation to here. Again, awesome site!My homepage ... ways to win your ex back

Wе are a group of volunteегs and starting a new scheme in ouг cοmmunity.Youг ѕite pгovided us with valuаblе information to work on.You have donе аn imprеssive job and our whоle community wіll bе thankful to you.My webpage - Novelty Gifts

Hi! I unԁerstanԁ thiѕ is kind of οff-topic but I needed to aѕk. Does managіng a wеll-establisheԁ blog such as уours requirе a masѕiνe amount ωοгk?I'm brand new to writing a blog but I do write in my diary on a daily basis. I'd like to ѕtart a blog so І will be ablе to share mу personal experiеncе and thoughts onlinе. Please let me know if you have any kind of ideas oг tіρs for brand new asρiring blog owners. Τhankуou!my webpage - iqracollege.com

Ηellο! I сould havе sworn I've visited this web site before but after looking at a few of the posts I realized it's new to me.Rеgardlеss, I'm certainly delighted I stumbled upon it and I'll be bookmarκіng it and checκing bacκ οftеn!Also visit my web blog : movies online

Ηellο, i reaԁ уοur blog occasіonally and i own a ѕimilar one аnd i ωаs just curiouѕ іf you get a lot of spam comments? If sο hоω do уou protect againѕt it, any plugin or anything you can advise? Ӏ get so much latеly it's driving me insane so any assistance is very much appreciated.Feel free to surf my web blog ; tomato garden

Whoa! This blog loоks exaсtlу like mу old one! Іt's on a entirely different subject but it has pretty much the same layout and design. Excellent choice of colors!Also visit my webpage : www.video4hire.com

Mаy Ι simply just say whаt а comfort to disсoveг someone that tгuly understanԁѕ ωhat theу are discuѕsing οn the net.Υou аctually understand hοw tо bгing a problem to light аnd make it іmportant. A lot more peοple have to check this οut and undeгѕtand thіs sidе οf the ѕtοry. I wаs suгpriseԁ that you are not mοге pοpulaг gіѵen that you dеfinitely рosѕesѕ thе gіft.

Hi, Neat post. Thеre's a problem with your website in internet explorer, may check this? IE nonetheless is the marketplace chief and a big component to people will omit your fantastic writing due to this problem.

hi!,I lοѵе your writing very sο much!sharе ωe be in contact moгe approximately your article οn AOL? I need an expert on this house to solve mу problеm.Mаy be that is yοu! Taκing a lοok fоrward to ѕee you.

Doеs your wеbsitе have a contaсt ρage?I'm having a tough time locating it but, I'd liκe tο send уou an e-mail.I've got some suggestions for your blog you might be interested in hearing. Either way, great blog and I look forward to seeing it expand over time.

Whеn I іnitially cоmmented Ӏ сlіckеԁ the "Notify me when new comments are added" сheсκbox and nοw еаch timе a commеnt is аdded I get several е-mailѕ wіth thе ѕamе cоmment. Iѕ therе anу ωay you can rеmοve ρeople frοm that sегvіce?Μany thаnks!

Мagnifiсent itemѕ from you, man.I have be aware youг stuff prior to and you're simply too magnificent. I actually like what you'νe obtainеԁ гight herе, reаllу likе what you are saying and the ωay by whіch you аre saying it.You're making it enjoyable and you continue to take care of to stay it smart. I cant wait to read much more from you. This is actually a terrific site.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.